FORM 1023-EZ for KAIVALYA AYURVEDA INC

Field Data
EIN 47-1011220
Case Number EO-2016286-000193
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name KAIVALYA AYURVEDA INC
Organization’s Mailing Address 138 NE 1ST AVE
City HALLANDALE BEACH
State FL
ZIP 33009
Accounting period End 12
Primary contact name ROBERTO PORTOCARRERO
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

ROBERTO PORTOCARRERO
PRESIDENT
138 NE 1ST AVE
HALLANDALE BEACH FL 33009

Officer/Director/Trustee Two

OLGA SMITH
TREASURER
1000 NE 14TH AVE
HALLANDALE BEACH FL 33009

Officer/Director/Trustee Three

PAOLA CORTINEZ
SECRETARY
9770 NW 24TH
SUNRISE FL 33322

Organization’s website KAIVALYA-AYURVEDA.COM
Organization’s email KAIVALYAAYURVEDA@GMAIL.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 9/29/2016
Organization Incorporation State FL
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code E99 - Health - General and Rehabilitative N.E.C.
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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